California <strong>ADAP</strong> FORMULARIES ANTIRETROVIRALS NRTIs- abacavir (Ziagen), abacavir/lamivudine/zidovudine (Trizivir), didanosine (ddI, Videx ,Videx EC), lamivudine (Epivir, 3TC), lamivudine/zidovudine (Combivir), stavudine (d4T, Zerit), tenofovir (Viread), zalcitabine (ddC, HIVID), zidovudine (AZT, Retrovir). PIs- amprenavir (Agenerase), indinavir (Crixivan), lopinavir/ritonavir (Kaletra), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Fortovase, Invirase). NnRTIs- delavirdine (Rescriptor), efavirenz (Sustiva), nevirapine (Viramune). Other- hydroxyurea (Hydrea). OI DRUGS PHS “A1 OI”s- acyclovir (Zovirax), azithromycin (Zithromax), cidofovir (Vistide), clarithromycin (Biaxin), famciclovir (Famvir), fluconazole (Diflucan), foscarnet (Foscavir), ganciclovir (Cytovene), isoniazid (generic), itraconazole (Sporonox), leucovorin calcium (Wellcovorin), pyrazinamide (generic), pyrimethamine (Daraprim), rifampim (generic), sulfadiazine (oral generic), TMP/SMX (Bactrim, Septra). Other OIs- albendazole (Albenza), amikacin sulphate (generic injection), amoxicillin trihydrate (oral generic), amphotericin B (Fungizone), atovaquone (Mepron), bleomycin sulfate (Blenoxane), ciprofloxacin (Cipro), clindamycin (Cleocin), clofazimine (Lamprene), clotrimazole (Lotrimin, Mycelex), cyclophosphamide (Cytoxan), dapsone (Avlosulfon), dexamethasone (Decadron), doxorubicin (Adriamycin), epoetin alpha (Procrit), ethambutol (Myambutol), filgrastim (Neupogen), flucytosine (5FC, Ancobon), fomivirsen (Vitravene), ketoconazole (Nizoral), isoniazid/rifampin (generic), liposomal duanorubicin (DaunoXome), methotrexate (oral, injection), metronidazole (oral generic), nystatin (Mycostatin), paclitaxel (Taxol), paromomycin (Humatin), pentamidine (Nebupent, Pentam), prednisone (oral generic), rifabutin (Mycobutin), trimethoprim (Trimpex, Proloprim), trimetrexate glucuronate (NeuTrexin), valacyclovir (Valtrex), vinblastine sulfate (Velban), vincristine sulfate (Oncovin). Hepatitis C- interferon alfacon 1 (Infergen), interferon A-2A (Intron-A, Roferon-A), ribavirin (generic), ribavirin/interferon alpha 2B (Rebetron). TREATMENTS FOR METABOLIC DISORDERS Diabetic- glipizide (Glucotrol), rosiglitazone maleate (Avandia). Hyperlipidemia- atorvastatin (Lipitor), gemfibrozil (generic only), pravastatin (Pravachol), simvastatin (Zocor). Wasting- dronabinol (Marinol), megestrol acetate (Megace), nandrolone (Durabolin, Deca-Duranbolin), oxandrolone (Oxandrin), somatropin (Serostim), testosterone (generic injection, transdermal). ALL OTHERS alitretinoin gel (Panretin Gel), alprazolam (Xanax), amitriptyline hydrochloride (generic), bupropion HCL (Wellbutrin), buspiron HCL (BuSpar), cephalexin (oral generic), citalopram hydrobromide (Celexa), codeine w/wo ASA, APAP (oral generic), desipramine HCL (oral generic), dicloxacillin sodium (oral generic), diphenoxylate HCL (Lomotil), divalproex sodium (Depakote), doxycycline hyclate (oral generic), erythromycin (oral generic), famotidine (generic), fenoprofen calcium (oral generic), fentanyl (Duragesic, hospice clients only), fluoxetine HCL (Prozac), gabapentin (Neurontin), hepatitis A vaccine, hepatitis B vaccine, hydrocodone w/wo APAP (oral generic), ibuprofen-prescription strength (generic), imiquimod (Aldara), indomethacin (oral generic), ketoprofen (oral generic), ketorolac tromethamine (Toradol injection), lamotrigine (Lamictal), lansoprazole (Prevacid), levorphenol tartrate (Levo-Dromoran), loperamide HCL (generic), lorazepam (oral generic), methadone HCL (oral generic), metoclopramide (Reglan, Clopra), minocycline HCL (oral generic), morphine sulfate (oral generic), naproxen (oral generic), nefazodone HCL (Serzone), neomycin sulfate (oral generic), nortriptyline HCL (oral generic), olanzapine (Zyprexa), omeprazole (Prilosec), opium, tincture of, oxycodone w/wo ASA, APAP (oral generic), pancrelipase (Ultrase), paroxetine HCL (Paxil), penicillin V potassium (oral generic), pneumococcal vaccine (Pneumovax, Pnu-Immune), probenecid (generic), prochlorperazine (Compazine), promethazine (Phenergan), quetiapine fumarate (Seroquel), ranitidine HCL (prescription strength generic), risperidone (Risperdal), sertraline (Zoloft), sulindac (oral generic), tetracycline HCL (oral generic), trazodone HCL (oral generic), vancomycin HCL (oral generic), venlafaxine HCL (Effexor). Colorado ANTIRETROVIRALS NRTIs- abacavir (Ziagen), abacavir/lamivudine/zidovudine (Trizivir), didanosine (ddI, Videx, Videx EC), lamivudine (Epivir, 3TC), lamivudine/zidovudine (Combivir), stavudine (d4T, Zerit), tenofovir (Viread), zalcitabine (ddC, HIVID), zidovudine (AZT, Retrovir). PIs- amprenavir (Agenerase), indinavir (Crixivan), lopinavir/ritonavir (Kaletra), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Fortovase, Invirase). NnRTIs- delavirdine (Rescriptor), efavirenz (Sustiva), nevirapine (Viramune). OI DRUGS PHS “A1 OI”s- acyclovir (Zovirax), azithromycin (Zithromax), cidofovir (Vistide), clarithromycin (Biaxin), famciclovir (Famvir), fluconazole (Diflucan), foscarnet (Foscavir), ganciclovir (Cytovene), itraconazole (Sporonox), pyrimethamine (Daraprim), sulfadiazine, TMP/SMX (Bactrim,Septra). Other OIs- amphotericin (Fungizone), atovaquone (Mepron), clindamycin (Cleocin), clotrimazole (Mycelex), dapsone, ethambutol (Myambutol), pentamidine (Nebupent), rifabutin (Mycobutin), valacyclovir (Valtrex), valganciclovir (Valcyte). Hepatitis C- none.
Connecticut <strong>ADAP</strong> FORMULARIES ANTIRETROVIRALS NRTIs- abacavir (Ziagen), abacavir/lamivudine/zidovudine (Trizivir), didanosine (ddI, Videx), lamivudine (Epivir, 3TC), lamivudine/zidovudine (Combivir), stavudine (d4T, Zerit), tenofovir (Viread), zalcitabine (ddC, HIVID), zidovudine (AZT, Retrovir). PIs- amprenavir (Agenerase), indinavir (Crixivan), lopinavir/ritonavir (Kaletra), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Fortovase, Invirase). NnRTIs- delavirdine (Rescriptor), efavirenz (Sustiva), nevirapine (Viramune). Other- hydroxyurea (Hydrea). OI DRUGS PHS “A1 OI”s- acyclovir (Zovirax), azithromycin, clarithromycin (Biaxin), fluconazole (Diflucan), foscarnet (Foscavir), ganciclovir (Cytovene), itraconazole (Sporonox), leucovorin, pyrimethamine, sulfadiazine, TMP/SMX (Bactrim). Other OIs- amphotericin B (Fungizone B), atovaquone (Mepron), ciprofloxacin (Cipro), clindamycin (Cleocin), clotrimazole (Lotrimin, Mycelex), dapsone, erythropoietin (Epogen, Procrit), ethambutol (Myambutol), filgrastim (G-CSF, Neupogen), ketoconazole (Nizoral), metronidazole (Flagyl), nystatin, ofloxacin (Floxin), paromomycin (Humatin), pentamidine (Pentam 30, NebuPent), prednisone, primaquine, rifabutin (Mycobutin), terconazole (Terazol 3 & 7), trimethoprim (Proloprim), valcyclovir (Valtrex), valganciclovir (Valcyte). Hepatitis C- peg-interferon alfa-2b (PEG-Intron), ribavirin (Rebetol). TREATMENTS FOR METABOLIC DISORDERS Cardiac- atenolol (Tenormin), diltiazem HCL (Cardizem), hydrochlorothiazide (HCTZ), isosorbide mononitrate (Imdur), lisinopril (Prinivil, Zestril), nitroglycerin. Diabetic- glipizide (Glucotrol), insulin NPH, insulin regular. Hyperlipidemia- atorvastatin (Lipitor), fenofibrate (Tricor), gemfibrozil (Lopid), pravastatin (Pravachol). Wasting- dronabinol (Marinol), megestrol acetate (Megace), nandrolone deconoate (Deca-Duranbolin), oxandrolone (Oxandrin), oxymetholone (Anadrol-50), testosterone (Androgel), testosterone (Androderm), testosterone cypionate (Depo-Testosterone). ALL OTHERS alprazolam (Xanax), amitriptyline (Elavil), amoxicillin, amoxicillin/Pot. Clavulante (Augmentin), cefuroxime, cephalexin, chlorhexidine gluconate (Peridex), citalopram hydrobromide (Celexa), codeine phosphate/acetominophen, Comvax, dicloxacillin, diphenoxylate HCL (Lomotil, Lonox), doxycycline, Engerix-B, fentanyl patch (Duragesic), gabapentin (Neurontin), guaifenesin/pseudoephedrine (Entex PSE), Havrix, hydrocortisone (cream/lotion/ointment), hydroxyzine HCL (Atarax), lactic acid, lithium (Eskalith), loperamide HCL (Imodium), lorazepam (Generics only), monetasone furoate monohydrate (Nasonex), olanzapine (Zyprexa), oxycodone HCL controlled release (Oxycontin), paroxetine HCL (Paxil), pneumococcal vaccine, prochloparazine (Compazine), Recombivax HB, sertraline (Zoloft), triamcinolone (acetonide cream/ointment), Twinrix, vancomycin, Vaqta, venlaxifine HCL (Effexor).
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